Healthcare-associated infections (HAIs) are among the leading causes of preventable death in the United States, and are associated with substantial morbidity, mortality, and financial costs. Treatment of HAIs has become increasingly difficult as antimicrobial resistance has increased and the number of effective antimicrobial agents has declined, and prevention of HAIs is thus of critical importance. The hospital clinical environment serves as a reservoir for the spread of nosocomial pathogens, most commonly via the hands of healthcare workers. Reducing these environmental reservoirs has been shown to reduce the incidence of HAIs but is difficult to assess and sustain. This project will explore a novel strategy to decrease HAIs through reduction of environmental reservoirs by replacement of intensive care unit (ICU) high touch surfaces with an inherently antimicrobial surface, copper. Copper has been shown both in vitro and in clinical environments to kill microorganisms such as MRSA and C. difficile on contact. The overall approach will be to conduct a prospective, randomized, double blind clinical trial assessing the efficacy of copper touch surfaces compared with two control surfaces at decreasing the incidence of HAIs (Aim 1). The copper surfaces will be compared to standard conventional surfaces and to copper-tinted stainless steel control surfaces. The microbial burden of the surfaces will be assessed and compared to confirm that reductions in HAIs are due to reductions in bacterial counts. If copper is effective in reducing HAIs, it is critical to consider the cost-effectiveness of refitting intensive care units with coppr surfaces. To assess the benefits and costs of the intervention, we will conduct a cost- effectiveness analysis (Aim 2) from the medical center perspective to assess how sustainable this intervention may be for medical centers. If copper touch surfaces are found to reduce the incidence of HAIs, and especially if the costs are favorable, these studies could lead to more effective and cost-efficient ways of reducing the incidence of HAIs. This project therefore addresses the recent focus of AHRQ on novel approaches to prevention and reduction of healthcare-associated infections.